Can Congress stop the 2027 pay cut? with Anders Gilberg of MGMA

The final 2027 Medicare Physician Fee Schedule, which the Centers for Medicare & Medicaid Services (CMS) released Nov. 4, cuts the conversion factor 2.31% for most clinicians, a deeper cut than CMS proposed in July. Practices have less than 60 days to retrain billing teams before the rule takes effect Jan. 1.

Anders Gilberg, senior vice president of government affairs at the Medical Group Management Association (MGMA), says the final rule scaled back a proposed cut to same-day office visits and procedures from 50% to 20%, but budget neutrality rules turned that improvement into a bigger conversion factor cut.

MGMA wants Congress to fix both immediately, and the Same Day Care Coalition says CMS still hasn't shown the data to justify a 20% reduction.

Physicians Practice Managing Editor Keith Reynolds sat down with Gilberg to talk through what practice leaders should do now. Gilberg explains how to run a practice's most-billed codes through the new rates, which specialties will feel the same-day cut most and what Congress could still do before government funding runs out Dec. 11.

He also covers the end of the Merit-based Incentive Payment System (MIPS), why the Patients First Act made Democrats' 100-day priority list, the administration's focus on fraud and the prior authorization bill he says has no reason not to pass this fall.

For more on the final rule, see what physician advocates are flagging for practices, listen to our special report on the cuts and hear Gilberg's take on the proposed same-day cut in September.

Music Credits:

Cozy Evening Coffee Time by BJBeats - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:40 | Cold open Gilberg on why a 20% same-day cut is still significant for practices running on thin margins.

0:40 – 1:33 | Introduction Keith Reynolds introduces the episode and the guest.

1:33 – 2:49 | The cut or the new Congress? Gilberg says most of MGMA's priorities are bipartisan, but the current Congress hasn't been productive and health care hasn't been a focus.

2:49 – 4:37 | Why the final cut is deeper CMS scaled the same-day policy back from 50% to 20%, and budget neutrality rules made up the difference with a bigger conversion factor cut.

4:37 – 5:56 | A real win? Gilberg says 20% is still high, and the Same Day Care Coalition says CMS made the decision without real data.

5:56 – 6:55 | Who gets hit hardest Orthopedics and dermatology top the list, and some patients may have to come back another day for a procedure.

6:55 – 9:15 | Can the lame duck act? With funding expiring Dec. 11, Gilberg lists what MGMA wants in a year-end package: another 2.5% payment increase, a restored floor on the geographic work index, an APM bonus and relief from lab cuts.

9:15 – 11:30 | The new Democratic Congress Gilberg expects early action on Medicaid cuts and ACA subsidies and points to the Patients First Act on Democrats' 100-day list.

11:30 – 13:46 | Will new leadership speed things up? Gilberg says Democrats still have to settle their own approach to health care, and some Republicans have since backed reversing Medicaid cuts.

13:46 – 15:20 | The end of MIPS Gilberg calls MIPS Value Pathways "MIPS on steroids" and says a phase-out set for 2030 or 2031 leaves time to revisit it.

15:20 – 16:12 | P2 Management Minute Keith Reynolds invites listeners to submit their own practice management tips.

16:12 – 18:10 | Getting ready for Jan. 1 Gilberg says practices should check the specialty impact tables, run their most-billed codes through the new conversion factor and review big policies such as the delayed remote patient monitoring change.

18:10 – 20:35 | HHS oversight and the political climate Gilberg expects oversight hearings instead of impeachment and warns that a fight with the administration could slow bipartisan bills.

20:35 – 22:11 | The fraud focus Gilberg says fraud is real but politicized, and attacking it won't fix the health care system.

22:11 – 23:55 | What he's watching on the Hill Physician payment and prior authorization reform, which Gilberg says has a supermajority of sponsors and costs nothing.

23:55 – 24:20 | Closing thoughts Gilberg wishes listeners a good holiday season.

24:20 – End | Outro Reynolds wraps the episode.